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NPI Code Detail

MEDICARE: DR. DALLIN RICHARD GILLETTE DO

MEDICARE: DR. DALLIN RICHARD GILLETTE DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1316524192
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DALLIN RICHARD GILLETTE DO
Provider Business Mailing Address
First Line : 9300 W SUNSET RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-4844
Country : US
Telephone Number : 702-916-6904
Fax Number :
Provider Business Practice Location Address
First Line : 9300 W SUNSET RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-4844
Country : US
Telephone Number : 702-916-6904
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2021
Last Update Date : 06/08/2026

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